Home Air In Agriculture - Pediatric Intervention Trial (HAPI)

描述（由申请人提供）：我们基于社区的参与性研究旨在减少居住在密集的乳制品和农作物农业生产地区的拉丁裔儿童环境正义社区的家中接触哮喘。这些哮喘儿童的发病率很高，我们的初步研究发现，细颗粒物和氨的环境浓度的显着影响。然而，孩子们大部分时间都在室内度过。在城市环境中进行的研究表明，室内颗粒物（PM）会影响哮喘的结果，HEPA（高效颗粒空气）清洁剂可以减少室内和环境产生的PM。关于农村地区哮喘的数据很少，也缺乏使用HEPA便携式空气净化器的试验。本研究旨在描述居住在作物生产或乳制品经营400米范围内的[75名哮喘儿童]的关键室内污染物暴露特征。受试者招募利用现有的社区卫生工作者提供的哮喘教育计划，由该地区的联邦合格的健康中心。6-12岁哮喘控制不佳的儿童将随机接受常规教育计划或增强版，其中包括2台便携式房间HEPA清洁器（儿童睡眠区，客厅）[带有旨在减少PM和氨（NH3）的过滤器]。常规项目组的儿童将在学习结束时获得HEPA清洁剂。优先考虑参与者负担低的方法以及创新方法 我们将评估加强干预措施在以下方面的有效性：1）减少跨季节的室内PM和NH3测量，2。改善哮喘健康的临床相关措施（哮喘控制问卷，肺量计，口服类固醇治疗，计划外临床使用），和3。减少炎症的生物标志物（尿半胱氨酸白三烯-LTE 4，呼出的一氧化氮）。护理人员的心理社会压力和行为成分将作为这些影响的介质进行评估。研究设计，程序，为多个利益相关者翻译研究结果，并制定环境行动计划以控制/消除暴露，这些都是在El Proyecto Bienestar，一个长期的UW社区研究行动伙伴关系中进行的。该项目纳入了NIEHS 2012-17战略主题中的每一个，并直接涉及11个次级目标中的7个。

DESCRIPTION (provided by applicant): Our community based participatory research seeks to reduce exposure to asthmagens in the homes of an environmental justice community of Latino children residing in an area of intense dairy and crop based agricultural production. These children with asthma experience high morbidity and our preliminary research finds significant effects of ambient concentrations of fine particulate matter and ammonia. Yet children spend the majority of their time indoors. Studies conducted in urban settings demonstrate that indoor particulate matter (PM) influences asthma outcomes and HEPA (high efficiency particulate air) cleaners can reduce indoor and ambient generated PM. Data on asthma in rural settings is sparse and trials incorporating HEPA portable air cleaners are lacking. This study seeks to characterize key indoor pollutant exposures for [75 children with asthma] who reside within 400 meters of crop production or dairy operations. Subject recruitment utilizes an existing community health worker delivered asthma education program operated by the region's federally qualified health center. Children aged 6-12 years with poorly controlled asthma will be randomized to the usual educational program or an enhanced version, which includes 2 portable room HEPA cleaners (child sleeping area, living room) [with filters designed to reduce PM and ammonia (NH3)]. Children in the usual program group will receive HEPA cleaners at the end of their study year. Prioritizing methods with low participant burden as well as innovative approaches, we will evaluate the effectiveness of the enhanced intervention on 1) Reducing indoor measures of PM and NH3 across seasons, 2. Improving clinically relevant measures of asthma health (Asthma Control Questionnaire, spirometer, oral steroid treatment, unscheduled clinical utilization), and 3. Reducing biomarkers of inflammation (urinary cysteine leukotriene - LTE4, exhaled nitric oxide). Caregiver psychosocial stress and behavioral components will be evaluated as mediators of these effects. The study design, procedures, translation of research results for multiple stakeholders and development of an environmental action plan to control/eliminate exposures are conducted within El Proyecto Bienestar, a longstanding UW-community research to action partnership. The project incorporates each of the NIEHS 2012-17 strategic themes and directly addresses 7 of the 11 sub goals.